Provider Demographics
NPI:1700827359
Name:MELTZER, DAVID WILLIAM (PHD, MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WILLIAM
Last Name:MELTZER
Suffix:
Gender:M
Credentials:PHD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8210 WALNUT HILL LN
Mailing Address - Street 2:SUITE 109
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4405
Mailing Address - Country:US
Mailing Address - Phone:214-368-2020
Mailing Address - Fax:214-692-7836
Practice Address - Street 1:8210 WALNUT HILL LN
Practice Address - Street 2:SUITE 109
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4405
Practice Address - Country:US
Practice Address - Phone:214-368-2020
Practice Address - Fax:214-692-7836
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4653174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG4653OtherTEXAS STATE MEDICAL LIC
TX00G634Medicare PIN
TXG4653OtherTEXAS STATE MEDICAL LIC
00G634Medicare ID - Type Unspecified